Benefits: MassHealth
Benefits: What is MassHealth?
MassHealth is the Medicaid program in Massachusetts. The program is funded by federal and state money, and provides health care coverage for low- and moderate-income residents of Massachusetts.
The Office of Medicaid within the Executive Office of Health and Human Services administers MassHealth in accordance with federal and state rules. Different rules apply to the following two groups:
- Individuals under 65 years of age living in the community and people of any age who live in a nursing home or a rehabilitation facility
- Seniors who are 65 and older.
Who is eligible for MassHealth?
You may be eligible for MassHealth if all of the following apply to you:
- You are a Massachusetts resident
- You are a U.S. Citizen, a permanent legal resident, or have other legal immigration status
- Your income is low or moderate
- You fall into any of the following groups:
- You have a disability
- You are a parent or an adult caretaker or relative living with your children under age 19
- You are under age 19 (whether or not you live with your family)
- You are 65 years of age or older
- You are pregnant
- You are long-term unemployed
- You are HIV positive
To learn more about eligibility requirements, click here.
How to Enroll
You can apply for MassHealth:
- By mail: MassHealth Enrollment Center, Central Processing Unit, P.O. Box 290794, Charlestown, MA 02129-0214
- In person at the MassHealth Enrollment Center. Find one near you.
- On the internet at a hospital, health center, or another authorized site
If you receive SSI benefits you are eligible for MassHealth automatically, without a separate application.
If you receive SSDI benefits you may meet the MassHealth disability standard, but must submit an application, the MassHealth Benefit Request to receive MassHealth coverage.
If you receive Transitional Aid to Families with Dependent Children (TAFDC) or Emergency Aid to the Elderly, Disabled and Children (EAEDC) you are eligible for MassHealth automatically, without a separate application.
If you do not receive SSI, TAFDC, or EAEDC you must apply for MassHealth separately. People under 65 must submit a Medical Benefit Request (MBR). Seniors (65+) and people of any age who require long term nursing care must submit a Senior-Medical Benefit Request (S-MBR).
You must submit the following proof with your Medical Benefit Request (MBR):
- Income from all sources
- Information about assets (if you are age 65 and older or if you are institutionalized)
- Citizenship status
- Immigration status
- Health Insurance (if you have health insurance from another source in addition to MassHealth)
- HIV-positive status (if you are applying based on HIV-positive status)
- Blindness (if you are applying based on blindness you must submit a certification of blindness or other medical documentation describing the nature of your visual impairment)
You can read more about the MassHealth application process by clicking here.
Call MassHealth Enrollment Center at 1-888-665-9993 or Customer Service Center at 800-841-2900, TTY 1-800-497-4648 to request application forms.
To find out if you qualify financially for any of the MassHealth programs, click here.
How long is the application process?
MassHealth must make an eligibility decision within 45 days of receipt of an application. If a determination of disability is required, the decision may take up to 90 days.
MassHealth will send a notice of eligibility if it approves your application, or a denial notice if it decides that you do not meet the eligibility rules.
What medical services does MassHealth cover?
There are several different kinds of MassHealth programs that provide different levels of coverage. Eligibility rules, scope of covered benefits, premiums, and other costs are different for different programs.
Whenever MassHealth determines eligibility a computerized eligibility system elects the MassHealth coverage type with the most comprehensive benefits for which you are eligible.
MassHealth programs are:
- MassHealth Standard
- MassHealth CommonHealth (link to the MassWINS MassHealth Factsheet)
- MassHealth Family Assistance
- MassHealth Basic
- MassHealth Essential
- MassHealth Limited (emergency Medicaid)
- Medicare Savings Programs (helps to pay Medicare premiums)
- Healthy Start (prenatal care)
- Children’s Medical Security Plan (primary and preventive care).
What kind of MassHealth programs provide coverage for SSI recipients?
Individuals receiving SSI cash benefits are automatically eligible for MassHealth Standard.
Individuals receiving SSDI benefits may be eligible for MassHealth Standard if their total countable income does not exceed 133% of the Federal Poverty Level (FPL). For those who are 65 or over, the countable income cannot exceed 100% of the Federal Poverty Level (FPL).
Of all the MassHealth programs, MassHealth Standard pays for the most comprehensive level of services. If you have Medicare and MassHealth (“dually eligible”) you must use MassHealth as a secondary insurance. This means that all of your bills should be submitted to Medicare first with MassHealth paying for those medical services that Medicare does not cover.
How long will someone remain eligible for MassHealth?
- There is no time limit for MassHealth.
- MassHealth will request information at least once a year to determine if you continue to meet all of the eligibility requirements.
- It is very important to respond to any MassHealth request for information and fill out the annual eligibility redetermination forms. MassHealth may terminate your benefits if you do not return the necessary paperwork at renewal.
Other programs for people with disabilities in Massachusetts
Home and Community Based Services Waiver
- MassHealth covers services to adults with intellectual disabilities who live in the community. The Department of Developmental Services manages the service delivery. Separate programs under HCBS waiver cover services for frail elders, young children with autism spectrum disorders, and adults with traumatic brain injuries.
- Kaileigh Mulligan Program (Home Care for Disabled Children) A program for children with severe disabilities who require skilled nursing care at home, the program does not count parents’ income or assets in determining financial eligibility.
- Program of All Inclusive Care for the Elderly (PACE) Medicare and MassHealth covered services for those ages 55 and older who need help with daily personal care and who have a medical condition requiring regular attention in order to live at home. Click here to view a list of PACE providers by state.
- Commonwealth Care A health insurance program for low and moderate-income Massachusetts residents who do not qualify for MassHealth programs.
- Prescription Advantage (no minimum age) A prescription drug insurance plan that is available to Massachusetts residents age 65 and older, as well as younger individuals with disabilities who meet income and employment guidelines.
- Massachusetts Home Care (for individuals age 60 and over or who have a diagnosis of Alzheimer’s disease) Support services to elders with daily living needs to help maintain independent community living.
- Health Safety Net (no minimum age) The program pays acute care hospitals and community health centers for essential health care services provided to uninsured and underinsured Massachusetts residents.
Sources of Information
Executive Office of Health and Human Services
MassHealth Contact Information